title: Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands.
abstract: OBJECTIVE
  Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of remifentanil-based regimen with conventional sedation and analgesia.
  
  
  METHODS
  Centre randomised, open-label, crossover, 'real-life' study.
  
  
  METHODS
  15 Dutch hospitals.
  
  
  METHODS
  Adult medical and post-surgical ICU patients with anticipated short-term (2-3 days) MV.
  
  
  METHODS
  Patient cohorts were randomised to remifentanil-based regimen (n = 96) with propofol as required, for a maximum of 10 days, or to conventional regimens (n = 109) of propofol, midazolam or lorazepam combined with fentanyl or morphine.
  
  
  RESULTS
  Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation (MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen reduced median weaning time by 18.9 h (P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS). However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely to be extubated (P = 0.018) and discharged from the ICU (P = 0.05) on day 1-3. Propofol doses were reduced by 20% (P = 0.05). Remifentanil also improved sedation-agitation scores (P < 0.0001) and intensivist/ICU nurse satisfaction (P < 0.0001). All other outcomes were comparable.
  
  
  CONCLUSIONS
  In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and agitation levels and reduces weaning time. This contributes to a shorter duration of MV and ICU-LOS.
authors.affiliation: Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: F Willem
authors.initials: FW
authors.lastname: Rozendaal
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Ferdinand F
authors.initials: FF
authors.lastname: Snellen
authors.forename: Adri
authors.initials: A
authors.lastname: Schoen
authors.forename: Arthur R H
authors.initials: AR
authors.lastname: van Zanten
authors.forename: Norbert A
authors.initials: NA
authors.lastname: Foudraine
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
mesh_terms: D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D011595:Psychomotor Agitation / Q000453:epidemiology / Q000517:prevention & control; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000628:therapy*; D015300:Ventilator Weaning / Q000706:statistics & numerical data*
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol